Maxillofacial Surgery Flashcards
Signs and symptoms of maxillary fracture? (7)
pain, swelling, diplopia, assymetry, nose bleed,
altered sensation
mobility
Classification of maxillary fractures?
Le Fort classification
- horizontal
- tooth bearing area detached - pyramidal
- involves nasal bone and infraorbital rim - transverse
- whole maxilla detached from base of skull
involves FZ sutures.
SI for maxillary fractures?
Occipitomental 15 and 30
mgmt maxillary fractures?
monitor
pain relief
ORIF
closed reduction
6 signs of a zygomatico-orbital fracture?
numbness of cheek diplopia assymetry periorbital ecchymosis subconjunctival haemorrhage enopthalmus laceration swelling, then flattening of zygoma decrease in visual acuity pain on eye movement
rads for zygomatico-orbital fracture?
occipitomental 15 and 30
tx zygomatico-orbital fracture?
conservative management and monitor
ORIF
closed reduction
post op advice zygomatico-orbital fracture tx
avoid blowing nose
pain management
observe for retrobulbar haemorrhage
signs and symptoms of mandibular fracture (8)
pain swelling assymetry occlusal derangement limited opening numbness AOB step deformity
classification mandibular fractures
simple/compound/comminuted no. of fractures site of fracture size of fracture displaced/undisplaced favourable/unfavourable
investigations mandibular fracture
OPT and PA mandible rads
mgmt mandibular fractures?
simple/undisplaced - monitor, analgesics
compound/ displaced - ORIF
What is a cyst?
pathological cavity not filled with pus. can be filled with fluid, solid, semi-fluid
3 types of cysts and examples of each?
inflammatory, developmental and non-odontogenic
inflammatory- radicular, residual, lateral, paradental
developmental - dentigerous, KCOT, eruption, gingival
non-odontogenic - nasolabial, nasopalatine
Common treatments for cysts, pros and cons
enucleation- removal of whole lining, whole lining can be biopsied, allows primary healing BUT risks of: mandibular #, local damage, loss of tooth
marsupialisation- partial removal, when e is contraindicated. allows tooth eruption, easier BUT can close and reform, difficult after care, full cyst not examinable, slow healing, requires enucleation after
What is a KCOT
Origin of KCOT
Most problematic features of KCOT
keratocystic odontogenic tumour
Rest of Serres - from dental lamina
problematic::
recurrent- 40-60%
due to friable capsule & daughter cysts
later presentation as grows mesially-distally
Histological features of KCOT
thin keratinised epithelium corrugated surface thin friable lining daughter cysts flat basement membrane basal cell palisading parakeratosis
Radiographic features of KCOT
well defined, multilocular radiolucency
extends from angle of mandible to the body and upwards into ramus
bony wall - well demarcated and corticated
What condition are multiple KCOTs associated with
Gorlin- Goltz syndrome
Where do radicular cysts arise from?
epithelial rests of malassez
- part of cells making up periodontal ligament
developed from Hertwigs epithelial root sheath (HERS)
aka periapical cysts
How do radicular cysts appear histologically?
epithelial lined fluid filled cavity
non keratinised stratified squamous epithelium
rests of Malassez
connective tissue capsule w/ cholesterol clefts
hyaline/rushton bodies
How do radicular cysts appear radiographically?
well defined, round, radiolucency at apex of non vital tooth.
unilocular
corticated
continuous with lamina dura
Where do dentigerous cysts arise from?
dentigerous cysts most likely to be seen associated with:
Dental follicle at reduced enamel epithelium and crown
most likely seen in L8s and U3s
How do dentigerous cysts appear histologically?
Thin, non-keratinised stratified squamous epithelium.
attachment to tooth at or close to adj
flat basement membrane
no inflammation
How do dentigerous cysts appear radiographically?
unilocular, well circumscribed radiolucency
extending from ACJ of tooth
corticated margins
contains crown of unerupted tooth displaced from normal position
name 1 epithelial derived tumour
ameloblastoma
benign
more common in mandible
name 1 epithelial and mesenchyme derived tumour
odontoma
complex or compound
benign
most common odontogenic tumour
name 1 mesenchyme tumour
odontogenic myxoma
intraosseous neoplasm, benign but locally aggressive
indications for orthognathic surgery?
restore function and aesthetics
correct severe skeletal discrepancy
Risks orthognathic surgery?
relapse nerve damage bleeding infection tmd unrealistic pt expectations not met
2 types of maxillary surgery
Le Fort 1
Anterior maxillary osteotomy
2 types of mandibular surgery
BSSO bilateral saggital split osteotomy
VSSO vertical subsigmoid osteotomy
